Provider Demographics
NPI:1134202096
Name:PAULSON, LANCE DAVID (RPH, MS)
Entity type:Individual
Prefix:MR
First Name:LANCE
Middle Name:DAVID
Last Name:PAULSON
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5589 LA BUWI LN
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-9191
Mailing Address - Country:US
Mailing Address - Phone:608-849-4409
Mailing Address - Fax:608-246-0136
Practice Address - Street 1:2201 ZEIER RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-7415
Practice Address - Country:US
Practice Address - Phone:608-246-4233
Practice Address - Fax:608-246-0136
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10948-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist